Surgical antibiotic prophylaxis: more is not better

For the USA alone, in 2012, the estimated attributable financial impact of SSIs in adults in acute care hospitals was almost US$3·3 billion.3 A basic component of perioperative care bundles to reduce SSIs is the appropriate use of surgical antibiotic prophylaxis, including the right drug, dose, and timing of administration.4 Despite the recommendation that, for most procedures, continuation of antibiotic prophylaxis after surgery is not required, this is frequently not adhered to. In a global prevalence study in 2018, the proportion of patients receiving surgical antibiotic prophylaxis for longer than 24 h ranged from 30% to 93%.5 Prolonged antibiotic prophylaxis after surgery is associated with additional costs, an increased risk of antimicrobial resistance, and side-effects including acute kidney injury and Clostridioides difficile infection.6 In The Lancet Infectious Diseases, Stijn de Jonge and colleagues7 report the results of a systematic review and meta-analysis to reassess the effect of continuing antibiotic prophylaxis postoperatively. The authors examined whether fewer SSIs occurred with continued antibiotic prophylaxis after surgery than with its immediate discontinuation and, in a prespecified subgroup analysis, whether continued surgical antibiotic prophylaxis was of benefit when best practice standards of surgical antibiotic prophylaxis were not met.